"0.4%" — Sasha

Randi 00:00

Welcome to Changed By Cancer. I'm your host, Dr. Randi Paynter. If you are listening to us on your favorite audio platform today, you are hearing the soundtrack of a fully produced video episode. Today we are sitting down with Sasha, a business owner and parent from San Francisco who was diagnosed with an exceptionally rare form of breast cancer and who came to that diagnosis with a scientist's instinct for data and a deep commitment to equity.

Sasha's story is one of the most intellectually rich conversations we've had on this podcast. They walk us through the science of their unusual cancer type, what it really looks and feels like to navigate chemotherapy, and what the system gets right and terribly wrong, depending on who you are when you walk through the door. They also share something deeply personal: what it means to face cancer as a parent when you have already watched a parent die from it. The full video version of this episode, including the conversation in its entirety, is available on our YouTube channel and at ChangedByCancer.com.

But whether you are watching or listening, Sasha's clarity, honesty, and generous spirit come through in every word. Let's get into it. Welcome to Changed By Cancer. I'm your host, Dr. Randi Paynter. Before we dive into today's story, a quick reminder. I am a cancer epidemiologist. But I'm not your doctor or clinician. The conversations we have here are about personal experiences and systemic issues in health care. They are not medical advice. Please consult your own medical team for any health related decisions. Today I'm joined by Sasha, who lives in San Francisco, California. Sasha is a business owner, a parent, and someone who came into a cancer diagnosis with a scientist's instinct for data and a community organizers instinct for equity. Sasha, welcome. Why don't we start at the very beginning? How did you find out you had cancer?

Sasha 02:25

I am 50 years old, and so, like a lot of female bodied people of this age or people with breasts of this age, my doctors have been encouraging me to get started, to encourage me to get mammograms. And I had gotten my first mammogram about a year ago, which came back totally clear with medium dense breasts, but no red flags. In December of last year, I noticed a lump in my left breast and went and got a mammogram, went and saw my ObGyn who said, yes, that is a lump, and scheduled a mammogram. The mammogram didn't really pick up anything. And then the radiologist, as they do when there is something, when there is a finding of any sort, did an ultrasound as well. And the ultrasound came back with quite a few benign cysts. My oncologist calls my breasts busy. And, and then she paused and said, you know what? I'm seeing a shadow here, unrelated to the cyst. Do you mind if we just go ahead right now and do a biopsy? And so I said, yep. I said, go ahead. And she did a needle core biopsy. Took six cores. And then, two weeks later, I got a phone call saying that they had identified that I had invasive lobular carcinoma. So it is, in fact, an incidental finding, which, thank you, cysts. Like, one of the difficult things about invasive lobular carcinoma is that it doesn't grow like ductal carcinoma, which does grow in a lump. It lacks E-cadherin, which is a protein that helps cancers, that helps ductal cancer form in a lump. Instead, it grows in lines of cells and sheets. I sometimes refer to it as almost like a cobweb, which is likely wrong, but it helps me kind of think of it. And what that means is that it only shows up on mammograms about 30% of the time it is missed and so whenever you read studies about lobular carcinoma, there's always a big caveat that they put in there that says outcomes are worse for lobular carcinoma, but that's probably because it gets caught later because it isn't as obvious. So the fact that mine was caught at what they eventually determined was grade 1B, was very lucky. So then I started going through all of the tests, the blood tests and the CAT scan and the MRI and the ultrasounds and the everything. And eventually they determined that the overall size and again, this isn't mass, this is from the one end of the cancer to the other end of the cancer, it was 6.5cm. And again, that's quite a bit larger than they initially had predicted. You know, when they did the needle core biopsy, they were saying, oh, maybe 1.5cm. Then when they did, a fuller ultrasound, they said, oh, maybe 3cm. It was the MRI where they looked and said, oh, it's 6.5cm and a bunch of different foci. So it requires quite a bit of imaging to really get a full picture of something like this.

Randi 06:37

And ILC isn't rare in the cancer world. It's actually the second most common form of breast cancer. So about 10% of all breast cancers are ILC. So if 70% of those aren't caught by mamogram, we're talking about a significant proportion of cancers that are being missed at early stage.

Sasha 07:05

Now, in addition, they also found what they LCIS, which is, lobular carcinoma in situ and lobular carcinoma in situ is not considered cancer. It's not even considered pre-cancer. However, it is correlated with an increased risk in lobular cancer in both breasts. They don't know why. The surgeon said, where we generally go here is, on one track you get a lumpectomy and radiation, and on the other track you get a mastectomy. And she recommended a lumpectomy. Now after the MRI came back, we met again and she said, actually it is quite large. It's 6.5cm. And with all of the cysts, it actually makes it quite difficult to see. And so she changed her recommendation to be mastectomy, because she did not want to miss anything with a lumpectomy, given how, how complex visually the field was. So at that point she said, I'm going to recommend a mastectomy. And I said, I would like to do a bilateral mastectomy. And she said, that works for me.

Randi 08:39

Tell me about the HER2 piece of this. Because this is where your case becomes truly unusual.

Sasha 08:48

ILC is the second most common form of cancer. Breast cancer. And 90... about 90% of those are typed as heavily hormonally positive. So estrogen positive, progesterone positive and HER2 protein negative. About 6% of them are what is called triple negative or they're not positive for any of those. And about 4% of them are triple positive, which means that they're positive for the HER2 protein as well as the hormones. I'm HER2 positive, so I'm a triple positive ILC. Which means that my particular type of cancer is 0.4% of breast cancers. Which it makes it a really rare beastie. And in fact, it's very difficult... There's only one specialist who studies triple positive HER2 cancers in the country. And he's in Boston.

Randi 09:54

So what did the treatment plan look like once they had the whole picture?

Sasha 09:59

So the standard of care is really, at this point, they just look towards ductal cancer, which is more often HER2 positive, and follow the recommendations for that. So in my... Now one of the things about ILC is it tends to be quite slow growing. And, that means it's usually not a good candidate for chemo. So usual care for ILC is lumpectomy / mastectomy and/or radiation plus a variety of inhibitors. But with the HER2 positive that changed. And so, the recommendation from my team, is a course of six chemo sessions for what's a combo called TCHP, which is Taxotere, Carboplatin, Herceptin, and Perjeta. The Taxotere and Carboplatin are pretty standard chemo drugs. And the Herceptin and the Perjeta are specifically to target the HER2 protein. And then after that, come late June, I will get, bilateral mastectomy. And then after that, I will be on another infusion for the rest of the year. And there's still a question mark as to what that infusion is, because it will depend both on some current drugs that are under advisement or if the clinical staging comes back after my mastectomy as being unexpected. So I have just finished my, just gone through my fourth round of chemo. I've got two more left, over half way. Very exciting.

Randi 11:55

I have to ask, how has chemo actually been? Because there's a lot of mythology about what it's actually like.

Sasha 12:03

Can't recommend chemo. Not fun. 0 out of 10. I'm not going to say... I'm not going to say 0 out of 10. Two out of ten. Two for killing the cancer, two for keeping me alive, eight for sucking while doing it. You know, one of the things that I've experienced around my care with cancer is that it's very individualized. And the doctors and the nurses have consistently been like, call us if you have any questions. And so and I meet with them before every round of chemo to go over how has the last round done? And they take my labs and we look at how is my body surviving. So one of the things we've been able to do through the first three rounds is fine tune some of the side effects, like the nausea and the GI effects and bone pains and things like that. And so those have gotten better each round. But, for instance, after my second round, my nausea was very bad. And so my... I met with my doctor at the end of that round and one thing they were very clear about is they do have other options and there is, so that if I am feeling what I feel, it'd be excessive nausea -- to contact, because I don't need to be stuck with a nausea drug that's not working. But the tiredness, and the brain fog have been cumulative. My poor body just doesn't have enough blood cells. It's trying so hard. One of the first things that my doctors told me, that was a surprise to me, was I should never throw up from nausea, that they expect my nausea to be controlled enough that I never throw up.

Randi 14:08

That's not the image most people have.

Sasha 14:11

We have an image of cancer, of somebody bald, which, here I am. I'm bald. But, we have an image of cancer of losing all your hair, throwing up constantly, unable to move, that has been carried through in media for a very long time. And it is the worst case scenario. This fear, this wall of fear around it has also prevented people from knowing the details of it. And I think it's prevented people from sharing the details of it.

Randi 14:52

Sasha, you came into this with a very particular set of tools. Can you talk to me a bit about how you've navigated being your own advocate, especially when your doctors haven't seen this particular type of cancer very frequently?

Sasha 15:11

I'm a very science minded person, and one of the things I did when I was sort of starting down this road and looking into things was I did start to read lots of papers. And, there are a couple places where I've found other information. One is that there is a website, specifically an organization that's just about lobular cancer. And, for instance, one of the absolute fantastic resources that they have is a very long list of questions to ask your doctor, and they divide it into questions about testing, questions about long term maintenance, questions about surgery, questions about... And like having that question list on hand when I went into my first meeting was huge. And they also post about recent findings and things like that. I'm also in, on Facebook, a lobular cancer group. And this is a group of around 10,000 people from around the world, which is a huge wealth of information because even as rare as my cancer is, there's a bunch of people out of that 10,000 people who've had it. So I was able to do a search through their archives and about what has been the treatment protocols. And that was also comforting in seeing that, yeah, that this is how people have been treated. So one thing I did do was I have a friend who is a researcher in the cancer treatment field, who I've known since my frosh in college. His wife had just gone through breast cancer. So he was actually very much up on it. And he is somebody who knows how to read the papers. So he was able to gut check me, and able to say to me, they're likely going to recommend neoadjuvant therapy. They're likely going to recommend TCHP. That is the standard of care right now. And I think you should go with that recommendation. So when I did meet with my oncologist, I was very prepared for what she had to say. And what she said met up exactly what he had to say. So that was a piece of privilege that I had, having access to somebody with that knowledge.

Randi 17:48

That's a form of privilege worth naming. Having access to someone who can read and understand the papers.

Sasha 17:58

100%. My experience of cancer that I'm describing is as a white person, who is middle class, who has insurance through my work. And who has access to college educated peers, who has a network of college educated peers that I can rely on, and who can come into a situation with a doctor having read, having had access to all of that. And that gives me an incredible leg up on somebody who might be coming in, especially if they're a woman, especially if they're fat, who might be coming in with a complaint, who is told to lose weight, eat better food, etc., etc. And may have cancer of the GI tract that is missed for six months.  And is afraid to go to the doctor in the first place for money reasons, for reasons of past negative experiences. I met with my surgeon recently as sort of halfway point and she did a manual exam. She said, I think it's a little smaller. And I said, I would like you to do a ultrasound too. And she said, okay, with the caveat I'm not a radiologist. And I said, yeah, understood. And so she did an ultrasound and she's like, oh, they're the cysts. And then she goes, true quote, My manual exam was garbage. My radiology is garbage.  She said, she goes, no, that dimple was scar tissue. I didn't feel anything. I can't see anything. Now, she did take that ultrasound and she went and compared it to the ultrasound that the radiologist took, and she said, okay, well, I don't see the shadowing that the radiologist saw before. So hopefully that's an indication that it's shrinking because of the chemo. She said, But basically we cannot trust a manual exam. And that was for me definitely a good reminder in advocating for myself. Because that was exactly one of the things that I..., the outcomes that I was thinking might happen, and I wanted that on the record that they could not trust a manual exam in this case. And because of that, one of the tricky things with ILC is that they don't really know until the end whether -- because I'm HER2 positive -- they don't really know until the end how effective the chemo has been.

Randi 20:58

I want to talk about family because your situation is layered in a really important way. You recently lost a parent to cancer, and you're a parent who now has cancer. Can you walk us a little bit through that?

Sasha 21:19

My mother died about four years ago of liver cancer, and hers was lifestyle related. She had Hep C, and despite getting the cure for Hep C, she had had it long enough -- she got it in the 80s -- and despite having a cure for it, she'd had it long enough that it had done irreversible damage to her liver, and it caught up with her. And they caught it very late. And so she was diagnosed and died six months later. Death from liver cancer is not a pretty sight. It's very difficult. It's painful. It's confusing. It's all of that stuff. One of the things we wanted to make sure -- I have a 13 year old son -- and one of the things we want to make sure of when we told him, was to make sure that he realized right away that this was not the same situation. We waited until after we had the treatment plan from the doctors to tell him, because I wanted to be able to give him as many answers as I could. And we sat him down and said, hey, (my partner and I) sat him down and said, hey, we've got news. And I said to him, I've got good news and bad news. I'm going to tell you the bad news first, but I want you to listen to the good news before you let yourself react to the bad news. I said, I have cancer, but it is early. The bad news is that the bad news is that I have cancer. But the good news is that it's very early stage and it's very treatable, and that there aren't any fears about survival. It's just going to be a sucky year. His reaction was, what the fuck? This is what he kept saying. Saying, what the fuck? What the fuck? What the fuck? And then he kind of like, he had to take it in. And let him ask a bunch of questions. And we explained to him, this is what the treatment is. This is what it's going to look like. This is when everything's going to happen, and I let him ask questions. And he's used to me being a pillar in his life. So he's like, who's going to get me up in the morning? I got that kind of stuff. His questions were also quite practical. And then we even try to involve him in ways that are appropriate and ways that kind of make him feel like he's got control of the situation. So, for instance, when my hair started falling out after my chemo, I said to him, hey, I'm going to shave my head. Would you like to give me a hairstyle, whatever you want, and then shave my head? And he was so down, he was so excited. So he got a chance to give me a green mohawk, and we got a bunch of ice cream, because I would have gotten drinks, too, but I'm not allowed to drink. So we got a bunch of ice cream and we taught him how to use clippers, and he dyed my hair, and gave me a mohawk, and shaved it all off. And it was a big family event. There was a lot of laughter and a lot of love. And he was very proud of himself. And he got to go to school and say that he gave his mom a green mohawk. And he's helped me out. At times it will be like, hey kiddo, can you refill my water bottle? Would you mind doing this or that? Or, I'm not going to be able to make you dinner tonight. What can you figure out? And he's been very game. And I'm also happy to see that he's still very much a teenager.

Randi 25:11

You've been pretty thoughtful about the question about how people can actually help. What have you learned?

Sasha 25:20

There wasn't a ton that other people could do to help. Among other things, I'm lucky enough that I can work from home when needed. I'm very close to the cancer center. And so rides really aren't a problem. Kaiser, at least at the Geary campus, doesn't let people stay with you while you have an infusion in order to protect immunocompromised folks. So people haven't been able to do that for me. I have had friends go with me to doctor's appointments to act as a scribe. With the assumption that I would need people to help, actually, I did set up a Caring Bridge. Caring Bridge has a meal train thing built in and people can subscribe and so you can ask for help through it and stuff. And I thought that I would use that to ask for the help that I needed. I haven't actually. Instead, I've used it as a blog, really, to kind of document my experience. I'm a very science minded person. I've used it to talk about the things that I've learned and some details of my experience. But I didn't use, I haven't used any of the meal train options or asked for help through it. I have had folks who have shown up on my doorstep and said, "Soup" and handed me soup, which is just great. And then I've had friends who came to me and said, can I make you food? What would you like? And there are a couple of books that are cancer specific recipes that... and so I've taken a couple of those, and there are a couple of other things that I thought would be useful that I've asked for. One of the ways in which cancer has deeply affected my life, in some ways, more than any. And this was, again, something that came as surprise, is eating. And so there are certain things... you don't want to, depending on your experience, you don't want to necessarily leave it up to folks of what to bring. Because, for instance, I can't eat anything sharp. And, things that are very carb heavy are very difficult for me to swallow. So things like soups are a lot easier. Lasagna was easier because the noodles were wet, you know? But, you kind of want to be able to have a little bit of control over what it is. One of the ways somebody, one friend gave me that, which was just, priceless gift, was she went to Kiehl's and walked in and said, I have a friend who's going on chemo. What should I give her? And the woman by the counter said, my mom went through chemo, and this is what I would have given her or what I gave her. And she put together a package of skincare stuff that was scentless, really gentle, that dealt with... like, an eye cream, which my eyes were so itchy and like, it was. And this was so... I'm not somebody who has ever used skin care products terribly much, but I got it and I was like, Oh my God, it's so great! And in fact, it is now my default gift. So that's something that a thing like that is something that I never would have thought to buy for myself. And in fact when I went, after I got diagnosed, and it was like, right before my first chemo, I thought, oh no, I've gotta get some stuff. And I went and I stood in a Whole Foods aisle. So I'm like, they'll probably have scentless stuff, right? And stood in the aisle and like, googled like "cream for cancer"? It's like, what? What are my Google search terms for this? And I just standing in the aisle going, this is so surreal! So that was a really... It was definitely one of those like core memory things, standing shell shocked at Whole Foods going, what am I doing? For folks who are looking for ways to help, a semi open ended offer is a good way to go. Like, hey, I have some time this weekend. Is there anything you need? Or, I'd like to drop off food for you. What would you like? Because if somebody says, let us know, between the brain fog and the busyness and the everything, remembering things in time is not always easy. So, being able to, say, being able to give a horizon time or specific type of offer is often very useful. So for the two friends who said, I'd like to give you food, what can I do? I was like, okay, great for my second round. I know I've got food covered because I've got these two friends. I'm going to give them assignments.

Randi 31:03

And for people who have more limited support networks, what would you say to them?

Sasha 31:10

For a lot of folks, they've got to put their lives on hold in some very unfortunate ways. And so money does help. Money. So even if it's trying to organize things like that. Or if somebody can't afford house cleaners, for instance, getting some folks together to do housecleaning, that's huge. Because that is exactly the kind of exertion where there have been several times where I've felt like I have energy to make dinner, and I've gotten through the making dinner part, and I have not gotten through the cleaning up part afterwards.

Randi 31:56

You've been getting your cancer care through Kaiser Permanente in San Francisco. From a systemic perspective, what has that looked like?

Sasha 32:08

Kaiser functions somewhat uniquely in American health care as acting both as the insurer and as the provider. What that means is frequently that when your doctor makes a referral, you generally do not need to argue with an insurer about it because your doctor is part of the insurance system. The day of the intake they have a team meeting, with everybody on the care team. And that includes the oncologist, surgeon, radiologist, patient care advocate. And they all meet. They go over the various test results, and they decide together what they think the best course of treatment is going in. And then later that day, I came in and I was in one place, and they filed through individually to talk to me about the overall findings and what they had come to recommend as a team. Having that kind of wraparound care for cancer is, it's a type of care I've never had before in the medical system. And I really wish it was more available for other types of care. After diagnosis, my calendar filled up with appointments. But I did not have to find where to get an MRI. I did not have to find where to get my CAT scan. I did not have to find a blood test, a place to get my blood tested. It was all under one roof. And then someone would call me and say, here's your... what's coming up. Be here at this time. Can you do that? Okay. How about this time? So I can't imagine how confusing, how difficult that would have been if I had had to find all of that myself. In addition, they signed me up for nutrition class, which is actually surprisingly helpful. I expected it to be eat a Mediterranean diet. Which there was a little of that, but there was also, if you can't eat and you need to get some protein in you, try peanut butter. If your throat is really hurting, here's the things you can do. So it was actually truly a cancer specific class. And then they sent us notes afterwards. I was offered therapy, and was able to get them to refer me out to their third party partner for therapy, which I would like to put this out there: Kaiser has a third party therapy partner. A lot of people, even in Kaiser, do not know about this. I only found out because a friend of mine told me, and my nurse practitioner did not know about it until I told her.

Randi 35:28

And how about the financial piece? Because that's a big part of what Changed By Cancer is all about.

Sasha 35:36

One of the things that blows my mind is that I was diagnosed in late December, and so my treatment really started in January. And so I hit my out-of-pocket max in February. And if I had gotten diagnosed in, say, September, this would all be costing me twice as much. Just a chance of the fact that I was diagnosed at the beginning of the year and I look at my... I added up what my off the shelf cost would be for a single chemo treatment. And it was something like $55,000. So one of the medications that I take, every course is called Granix. It's five shots that I take in order to prevent neutropenia, which is low white cell count, to prevent me from becoming super immunocompromised. And the Granix, is $2,000 a shot. And it costs me $40 for every 20, $40 for every ten shots. And I found this out because when I was talking to the pharmacist, the oncology pharmacist, they were explaining everything, and they're like, okay, and then there's Granix. And they're like, oh, good. You have good insurance. I said, what happens if somebody doesn't have good insurance? And he goes, well, that's where the foundation comes in. And we figure it out, but he's like, you don't have to worry about that.

Randi 37:28

Unfortunately, we both know that a lot of people do. We are both privileged that we are not who this system fails. I am and you are the person that the system was actually built for. Someone who has good insurance, savings, can work from home, lives close to an excellent cancer center, has health and science literacy and a network of educated and supportive friends. The fact that it's still complicated and scary and confusing tells you something about what it's like for someone that doesn't have all that.  So you've used a framework from the disability community to think about all of this. Can you explain what you mean?

Sasha 38:26

There's a lot of lessons to be learned there and so many directions. And I've referred to cancer, or at least my experience of it, as a very good example of what we call the social model of disability. And the social model of disability holds the disability is not in the ability of one's body, but it is in the relationship of one to society. So an example is that, probably the biggest example is that I'm able to work. Because I can work -- most of my work is on a laptop -- and most of it, I can do it from home. Now, for somebody who works at a checkout counter who is going to be disabled by chemo, it is now a disability because they can't sit in their bed and work the checkout counter. Their ability to work is now undermined. Some of it is place. I don't have to travel 4 to 6 hours to get adequate treatment for my cancer. And for folks who do, they have to take off work. They have to spend money on a hotel. Etc., etc. Universal design. Help me out. I was about to say universal design is real. Now everyone knows that there is no such thing as actual universal design. But when we create, when we do design, when we do accessibility for as many cases as possible, it helps everybody. And yes, stairs versus ramps is an excellent example. Curb cuts help people with strollers. And all of these were brought to you by disability activists. These were folks who climbed the steps of the Supreme Court and said, give us, let us be fully functional members of society. Let us be who we want to be. And it has helped all of us. We will all be disabled. We will all be disabled. And whether that's by injury, whether that's by age, whether that's by illness, at some point we will all be disabled.

Randi 40:50

I want to step back and ask before all of this, who are you? What does life look like on a day to day basis?

Sasha 41:00

I own a company of about 30 employees. It's a very long standing company. Company is about 40 years old, but I took over ownership, along with my business partner, in 19, not 19. In 2019. I have a 13 year old son, and then we've got my partner and our roommate, and I'm also non-binary. And one of the things I did when I was pregnant and now was I started writing mostly Facebook posts about my experience of pregnancy in a way that was interested in the science and kind of semi humorous and like, I would... Every week, I would look up what size vegetable my zygote or my kid was supposed to be and it's like, okay, we're going to have blueberry recipes this week. What are some good recipes with avocado? I'm going to have guacamole. And specifically at that point I also talked about being a nonbinary person, pregnant, because the constant "mama, you got this" -- and it's a very common... which for some people really fits. And for other folks like me, it doesn't so much. And again, the fears around a pregnancy, similarly, and there's reasons for some of them, it's a pretty huge thing you're putting your body through. But, I basically, yeah, I'd like to see an update to that. And so what I've done with the cancer as well is also I've been fairly public, you know, friends locked, but fairly public about my experience of -- for instance once I wrote, you know, just for funsies, I decided to count up all of the medications that I'm on. And then I listed them all and like what they were for, like 15 different medications for, like, Jesus Christ! And so I appreciate specifically what you're doing with this as well, you know, because I think, like you said, storytelling is a way to talk about this, and it's a way to kind of update those feelings and update those fears. Our attitude and I think that stuff needs to be more broadly known. There could be more characters in dramas who kind of casually have cancer and you're not looking at it as a, what's it called, an indication that they're going to die later. Because if a cancer has character, a character has cancer, they're probably going to die. But that's not the case. And again, one eighth of women are diagnosed with breast cancer at some point. One eighth of women are not dying from breast cancer!

Randi 44:13

How has this changed you? What does the changed by cancer part look like for Sasha?

Sasha 44:20

I knew right away that it was early stage, like that was clear. So when I was told it was in fact cancer, that was not benign, my first thought was, okay, what are the next steps? And that's really been how I've felt the whole time. I've never felt afraid. I've felt, you know, unease. And I've felt, you know, more fear, probably, of the process of chemo than of the cancer itself. But I've never been afraid of it. And I've been afraid of its impact on my life, of the impact of the treatment on my life. But, I think that because I've led with that very much that's also how it's affected my family. This is more of a group project. Oh, actually, there's a book I would recommend and here's another one just to put in notes is, that I found utterly fascinating -- The Emperor of All Maladies. And so it's about the history of cancer from ancient times to the modern era. And it covers social things. It covers the biology of cancer itself. And it covers the history of research. And I read it many years ago. Read it on a plane straight through one sitting from one post to the next because it was so fascinating. But it definitely informed how I came into this experience. Both in that it differentiates cancer so much and it goes deeply into how the research is done. And so it really created sort of my background in thinking about my experience. The hat that I'm wearing today was based on a recommendation from another friend of mine who'd had cancer. ... The Cancer Fighting Kitchen was a book that was bought for me, you know, not super expensive. Three friends bought it for me!

Randi 46:54

Sasha, thank you so much for being with us today and for sharing everything that you have. You've come in with the precision of a scientist, with a strong sense of equity, and with the honesty and the love of a parent. And you've named things that a lot of people feel but don't have words for, about what the system asks of us and what we ask of each other. And really what it means to be changed by cancer without letting it define you.

Sasha 47:35

I've really enjoyed it. Thank you so much for having me.

Randi 47:40

Thank you Sasha, and thank you to everyone for listening. You can find show notes and resource links and more at ChangedByCancer.com. I encourage you to subscribe and to leave a review on your platform of choice. It helps more people to find us. I'll catch you on the next episode.